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Stages of Recovery
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Imperfect Word, Good Models
First, let’s address that imperfect term, ‘recovery.’
- I know it can turn people off, especially some men.
- Here I simply mean ‘gradual healing,’ a standard meaning found in any dictionary.
- I am not suggesting that you view yourself as ‘in recovery,’ or in any other way make this concept part of your identity (though some may choose to do so).
Now, for the models. There are two that describe ‘stages of recovery’ people go through to overcome traumatic childhood experiences and other traumas.
Road maps of how people overcome the effects of traumatic experiences.
Both models are excellent. Both map common paths that many others, including people who once felt hopeless about ever being truly happy, have traveled with success.
I encourage you to learn about both models, of Judith Herman and Mic Hunter. The former was written primarily for women and the latter for men, but both models apply to both women and men.
Herman’s Stages of Recovery
In her classic book Trauma and Recovery, Judith Herman presents a three-stage model of recovery which describes in detail the healing process of people who struggle with a combination of problems related to unwanted, abusive, or traumatic experiences.
The problems may include:
- Difficulty regulating emotions and impulses
- Emotional numbing
- Anger and aggression
- Substance addictions
- Behavioral addictions (porn, anonymous sex, gambling, etc.)
- Self-harming behaviors (cutting, burning, etc.)
- Dissociation (spacing out, blanking out, losing time, etc.)
The first stage of dealing with and overcoming such problems, and of any helpful therapy or counseling, is about:
- Getting a ‘road map’ of the healing process.
- Setting treatment goals and learning about helpful approaches to reaching those goals.
- Establishing safety and stability in one’s body, one’s relationships, and the rest of one’s life.
- Tapping into and developing one’s own inner strengths, and any other potentially available resources for healing.
- Learning how to regulate one’s emotions and manage symptoms that cause suffering or make one feel unsafe.
- Developing and strengthening skills for managing painful and unwanted experiences, and minimizing unhelpful responses to them.
Most important, the key to healing from traumatic experiences in childhood is achieving these ‘stage-one’ goals of personal safety, genuine self-care, and healthy emotion-regulation capacities. Once these have become standard operating procedures, great progress and many new choices become possible.
Importantly, the first stage of recovery and treatment is not about discussing or ‘processing’ memories of unwanted or abusive experiences, let alone ‘recovering’ them. (For more on how the stages of recovery are related to memories of abuse, particularly recovered memories, see Personal Questions under Recovered Memories.)
Of course, everything is not always so perfectly ordered and sequential.
For example, during the first stage it may be necessary to discuss the contents of disturbing memories that are disrupting one’s life. This may be required to help manage the memories, or to understand why it is hard to care for oneself (e.g., the abuser acted like or even said you were unworthy of care or love). However, in this case addressing memories is not the focus of therapy, but a means to achieving safety, stability, and greater ability to take care of oneself.
Depending on the person, the first stage of treatment may also involve:
- Addressing problems with alcohol or drugs, depression, eating behaviors, physical health, panic attacks, and/or dissociation (e.g., spacing out, losing time).
- Taking medication to reduce anxiety and/or depressive symptoms, for example serotonergic reuptake inhibitors (SSRIs) like sertraline (Zoloft) or paroxetine (Paxil).
- Participating in Dialectical Behavior Therapy (DBT), a treatment for people having serious problems with tolerating and regulating emotions, interpersonal effectiveness, and/or self-harming behaviors.
Common to All Stages
Throughout all stages of treatment, it is often necessary to address psychological themes and ‘dynamics’ related to one’s history of unwanted or abusive experiences.
As discussed in Consequences of Abuse, some of these are core issues that should determine the very nature and structure of treatment. These include:
- Shame and guilt
- Reenacting abusive patterns in current relationships
In the first stage of treatment, these themes and dynamics must be addressed when they are obstacles to safety, self-care, and regulating one’s emotions and behavior. Therapy can help with recognizing habitual behavior patterns, beliefs, and motivations that maintain self-defeating and self-destructive behaviors outside of conscious awareness or reflection.
Increased awareness of these themes and dynamics brings greater understanding, greater ability to take responsibility for them, and greater capacities to choose new, healthier responses and actions. (Mindfulness meditation practices can also help cultivate such awareness and freedom; see Mindfulness and Meditation.)
This stage of recovery and treatment is often referred to as ‘remembrance and mourning.’
The main work of stage two involves:
- Reviewing and/or discussing memories to lessen their emotional intensity, to revise their meanings for one’s life and identity, etc.
- Working through grief about unwanted or abusive experiences and their negative effects on one’s life.
- Mourning or working through grief about good experiences that one did not have, but that all children deserve.
After establishing a solid foundation of understanding, safety, stability and self-regulation skills one can decide – mindful of the potential pain and risks involved – whether or not to engage in the work of stage two.
In fact, once the first stage of recovery has provided such a foundation, some people realize that thinking and talking about painful memories is not necessary to achieve their goals, at least in the short term. Some find that the memories are no longer disrupting their life and no longer of much interest to them. (And sometimes people need to teach their therapists about this!)
For those who choose to focus on disturbing memories, including because those memories are still disrupting their lives, several ‘memory processing’ methods can be used during this stage.
In general, these methods involve re-experiencing the memories within a safe and healing therapy setting. They can be very effective at ending the influence of such memories in one’s daily life.
Most importantly, there are very effective therapy methods that have been proven, through years of clinical experience and research, to bring great relief and healing by transforming memories and responses to reminders of harmful childhood experiences.
(Please note: None of these methods ‘erase’ memories, and they are not designed to ‘recover’ memories. If you have personal questions about this issue, see Personal Questions under Recovered Memories.)
One of the most research-supported approaches for processing traumatic memories is EMDR (a page I wrote for 1in6). This method can rapidly transform traumatic memories into non-traumatic ones – and you don’t have to talk about them in detail, if at all, making it a great option for some men and woman.
Again, the main point here is that there are effective and relatively rapid methods for dealing with intensely distressing memories. People do not have to be tortured by them for years.
The third stage of recovery focuses on reconnecting with people, meaningful activities, and other aspects of life.
I will not go into that stage here, but recommend reading Trauma and Recovery, which describes all three stages of recovery in depth and detail.
Hunter’s Stages of Recovery
This model is described in detail in Mic Hunter’s Abused Boys, one of the first books written for men struggling with the effects of unwanted or abusive boyhood sexual experiences.
The model comes from Hunter’s experiences of helping men and women sort out and overcome the effects of such experiences. It applies to both men and women dealing with the effects of any kind of child abuse, including emotional and physical abuse.
Hunter found parallels with the stages of grieving the loss of an important person in one’s life – which makes sense, because harmful childhood experiences and their effects are often experienced as causing one to ‘lose’ important aspects of oneself (for example, one’s masculinity or femininity, confidence, trust, or enjoyment of life).
1. Denial – ‘Nothing happened…’
Denial doesn’t necessarily mean refusing to acknowledge something that is true, though this can be the case. Rather, it refers to a variety of ways that people can – for very good reasons – push memories of unwanted childhood sexual experiences out of their awareness. These ways range from completely ‘blocking out’ or ‘splitting off’ memories, without even realizing it, at one extreme, to intentionally, and often with great effort, trying to keep memories and reminders from breaking into consciousness, at the other.
Most people who have had such experiences, but haven’t yet sorted them out or dealt with their effects, find themselves somewhere in the middle. They have clues that something happened, or fragments of memory that pop into awareness, but these are quickly pushed away or ‘blocked out’ whenever they come into awareness.
There are many reasons that people have for pushing such memories and related thoughts out of their minds. They can trigger unwanted feelings like anger, sadness, fear, or horror. They can trigger unwanted and disturbing thoughts – about one’s masculinity, about important people and relationships in one’s life (past and present), and about what would happen if such memories and thoughts were not always pushed away. As discussed in stages of change (which I wrote for 1in6), it is neither helpful nor respectful to push or try to convince a man to look at such memories or information which suggests that he may have had childhood sexual experiences that are causing him problems now.
On the other hand, as Hunter points out, it can be costly to keep such information out of awareness. In some cases, it uses ‘cognitive resources’ that are needed for other purposes, like ones school work or job responsibilities. It can keep one in constant (if unacknowledged) fear of experiencing any vulnerable emotions that could trigger unwanted feelings, thoughts and memories about the sexual experiences. This means being unable to experience or tolerate other people’s vulnerable emotions, which is necessary for caring about their suffering and doing the right thing to help.
Also, emotions tend to be a ‘package deal.’ Disconnection from negative emotions usually means experiencing few positive ones either, or not even getting close to experiencing one’s potential to have fun and be happy. people in this situation often find themselves feeling like they’re ‘going through the motions’ in important relationships – with friends, family, girlfriends or boyfriends, spouses or partners, even their children.
2. Bargaining – ‘Something happened, but…’
In this stage, the person acknowledges that something happened, but attempts to convince himself or herself (and others) that the experience wasn’t harmful and hasn’t caused them any problems – even though it has.
This is not to say that people can’t have unwanted or even abusive sexual experiences that do not cause problems in their lives. This is possible, for example, if the experience only happened once and the child’s life was otherwise full of healthy and positive relationships with family, friends, and other authority figures.
Instead, this stage refers to the experiences of people who are, on the one hand, no longer pushing away the fact that they had a potentially harmful sexual experience, while, on the other hand, they’re not yet ready to deal with the impact it continues to have on them. These mixed feelings are often expressed in ‘yes but’ thoughts and statements.
The ability to doubt the reality of what happened, or its effects on one’s current life, can be very strong at this stage. Also common is ‘pseudo-forgiveness,’ in which, as Hunter puts it, the person ‘attempts to move from denial straight into forgiveness without experiencing any of the emotions’ related to what happened. As Mike Lew puts it, “True forgiveness does not arise from denial. It can only occur when there has been a complete understanding of what has happened, including the nature of the wrongs and where the responsibility lies.”
Below are some common things said by men in this stage of recovery, from chapter 5 of Hunter’s book:
- ‘It didn’t happen enough for it to matter.’
- ‘I know what she did, and I wanted it.’
- ‘I can’t deny it happened, but it’s my fault that it happened.’
- ‘She was just teaching me about sex.’
- ‘I can’t do anything about it now. There’s no sense in even talking about it.’
One last observation, and a suggestion from Hunter:
“When in the bargaining stage, many people find that a constant argument or civil war goes on in their heads: ‘It really happened.’ ‘No, it didn’t.’ ‘Yes, it did.’ This goes back and forth, seemingly forever. If you find this happening, you may find it useful to choose a side and write a letter to yourself or someone else arguing that point, making no attempt to be objective or to see both sides. Once that is done, write another letter arguing the opposite side. Pay attention to your body during the writing of each letter, and listen to what your emotions are telling you” (Abused Boys, p.105).
3. Anger – ‘Something happened, and I’m angry about it!’
This is a third stage that many people experience. This stage begins when one recognizes not only that something happened, but that it really did harm him or her.
For some people, this is the beginning of believing that what was done to them matters because they matter. For those who have squelched their anger, or been unable to feel it, this may be the first recognition that experiencing and expressing anger can be helpful and healthy.
For some, this ‘opening to anger’ brings fear that they will lose control and hurt other people or themselves. This fear can be valid and healthy. In fact, realistic concerns about anger’s destructive potential tends to protect people from acting out violent thoughts and impulses that be triggered very suddenly.
Importantly, it’s almost impossible to be simultaneously angry about something done to you and blame yourself for it. For this reason, getting angry about what happened can bring relief from self-blaming thoughts. It can be the beginning of overcoming the tendency – which is especially common – to blame yourself for ways people took advantage of you when you were a child.
For many, the recognition that they are valuable human beings, and that what happened isn’t their fault, can bring a huge sense of relief. Also, the anger may also provide a lot of energy and motivation to make positive changes in one’s life. In these ways, this phase can bring a great deal of healing and progress.
At the same time, this can be a risky period. Anger may become a central player in one’s emotional life. It can ‘spill out’ in ways that are harmful to oneself or others. Or one may now feel ‘justified’ and ‘entitled’ to act in the same old angry ways one has for a long time, rather than taking responsibility for them. In addition to relief and empowerment, then, this stage can bring new challenges and responsibilities.
Another problem is that some people have trouble moving on from this stage. Whether consciously or not, they prefer anger to the sadness that is an essential part of recovery. Men especially are vulnerable to getting stuck in the anger phase, because they have been conditioned to feel safe and strong when they are angry, and fear that sadness equals weakness, even being a victim, even though, as described below, this is definitely not the case.
As Hunter points out, in this stage many people find that exercise is a great way to channel the ‘energy’ of anger or ‘vent’ angry feelings. Running, lifting weights, or playing active sports can not only channel the energy and help release the feelings, but increase one’s senses of being strong and powerful. Finally, for some people hitting a punching bag, or even an old mattress, can be a safe way to release anger when it wells up inside.
4. Sadness – ‘Something happened, and it cost me a lot.’
As Hunter writes, “Sadness comes when a man [or woman] realizes that he was wronged and that he [or she] has lost something that he can never retrieve.” This is when the grieving phase of the overall grieving process described by these stages really kicks in.
Harmful unwanted or abusive childhood sexual experiences bring many losses – of innocence, of trust in others, of belief in oneself, and of achievements that never happened thanks to the effects of the unwanted or abusive experiences.
Truly facing and reflecting on one’s many losses can bring a great deal of sadness. Sadness is a totally legitimate and justified response to such losses. It can be painful to experience, but coming to know this sadness can bring great strength, and deep appreciation and understanding of the suffering that are part of so many people’s lives.
During this phase people can become very sensitive. Not only their own pain and suffering, but that other people, and pets or other animals, can feel very intense. They may cry easily.
Hunter observes, “As a person moves through the sadness stage, he will notice how his tears change. At first, crying will be very difficult and painful. He may fight back the tears by holding his breath, not making any sound… or shaming himself for needing to cry. Later in this stage, the tears will seem to come from somewhere very deep and are often accompanied by a sense of being a small child. There is often a sense of great loss and loneliness.… Still later in the recovery process the tears are followed by a sense of healing, coming together, wholeness” (Abused Boys, p.111).
In short, in this stage of recovery one’s experiences of sadness become increasingly healing and strengthening.
Hunter and others have suggested several activities that can help bring about this transformation. One is writing ‘goodbye letters’ to things you have lost because of unwanted or abusive childhood experiences – “for example, the relationships you never had because of your shame and fear of intimacy, or the type of parents you never had, or the loss of your spontaneity” (Abused Boys, p.111).
5. Acceptance – ‘Something happened, and I have healed from it.’
Once again, a passage from Hunter’s book nicely sums up the essence of this stage:
“The final stage of grieving begins to take place when the person who was wronged has acknowledged [what happened], felt as well as expressed the emotions he has about it, and begins to put it in proper perspective. He no longer blames himself… or punishes himself for what he did or didn’t do in order to cope… He becomes less and less likely to see himself as helpless, hopeless, and defective. This will make him less vulnerable to further exploitation. He will begin to accept himself and treat himself with respect and affection. Although he will never forget what was done to him, he will be able to stop organizing his life… around it. He will have a scar rather than an open wound” (Abused Boys, p.113).
Acceptance here does not mean failing to see that what happened was harmful and wrong. Instead, it means accepting that the past cannot be changed, and coming to peace with it rather than remaining focused on pain or sadness, anger or resentment.
While it may be hard to imagine at the beginning of the recovery process, it really is possible to experience a sense of serenity about even the worst childhood experiences and the negative effects they once had.
The acceptance of this stage brings great strength and power. The strength and power come from having faced one’s life head-on, having truly experienced the worst of the past, and having arrived at a way of being that is free from either running away from painful truths or getting caught up in them.
With acceptance, one can truly ‘move on’ – as a person of greater courage, strength, hope, and wisdom.